Verteporfin photodynamic therapy for neovascular age-related ...

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130 Appendix 1Appendix 1: Classifying choroidal neovascularisation in the maculaThe table below describes a standardised method for determining the category of choroidal neo-vascularisation from stereoscopic fundusfluorescein angiograms. It is designed to help in the assessment of suitability of cases for treatment within the NICE recommendationsissued in 2003 but will be useful to all those involved in grading and assessing CNV. The decision tree includes recently developedterminology from grading centres involved in TAP, VIP and SFRADS. (Yit Chiun Yang, Usha Chakravarthy, Simon Harding – April 2004)A. Identify morphological featuresUse stereos of colour and angiographic frames to assist in recognitionof the following lesion componentsB. Assess totallesion sizeC. Categorise lesion subtype1. CNV Lesion ComponentsFluorescein leakage associated with CNVClassic CNVOccult CNV: fibrovascular PED; late leakage of undetermined originFeatures contiguous to CNV which prevent determination of extent ofleakage and which therefore constitute part of the lesionBloodElevated Blocked Fluorescence (EBF) not due to blood- may be due to RPE hyperplasia, thick exudate, fibrous tissueSerous PED2. Other features associated with CNV which are NOT used todefine the boundaries of the lesionAtrophy: geographic atrophy (GA) and non GAFlat blocked fluorescenceFibrosis not contiguous to CNV boundaryThick exudate not contiguous to CNV boundary3. Other features which help with categorisation of CNV or whichmay modify natural historyRetinal angiomatous proliferationChorio-retinal anastamosesIdiopathic polypoidal choroidopathy1. Define theboundaries of thelesion2. Define theboundaries of thearea of classicleakage3. Estimate proportionof classic relative tototal lesion size4. Ineligible for PDT ifless than 50% oflesion is CNV1. Classic with no occult (NICEFAD 1.1)1A. Classic leakage accounts for100% of lesion1B. Classic leakage accounts for50-99% but lesion has no occultcomponent2. Predominantly classic with occult(NICE FAD 1.2)Classic leakage accounts for 50-99% of lesion with some occult3. Minimally classicClassic leakage accounts for lessthan 50% of the lesion4. Occult with no classicClassic is 0%. Any CNV leakage is ofthe occult variety
DOI: 10.3310/hta16060Health Technology Assessment 2012; Vol. 16: No. 6131Appendix 2: Examples of flow charts for making re-treatment decisions.Belfast Belfast re-treatment re-treatment criteriacriteriaIs leakage present on FAIs leakage present on FANoNoYesYesDo not treat and arrange review for 3 MDo not treat and arrange review for 3 MIs leakage reduced when compared with pre-treatmentIs leakage reduced when compared with pre-treatmentYes NoYes NoRetreat with PDTRetreat with PDTHas there been a treatment related adverseHas eventthere been a treatment related adverseeventYesYesNoNoYesYesIs VA within 6 lines of last treatmentIs VA within 6 lines of last treatmentIf acute vision loss noted after treatment do not retreatIf acute vision loss noted after treatment do not retreatNoNoNo furtherNo therapyfurthertherapy© Queen’s Printer and Controller of HMSO 2012. This work was produced by Reeves et al. under the terms of a commissioning contract issued by theSecretary of State for Health.
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38 Results (1) - study cohortTABLE
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66 Discussion of resultsStrengths a
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74 Discussion of resultsVPDT. It is
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Page 98 and 99: 84 References16. Stelmack J. Qualit
Page 100 and 101: 86 References49. Guymer RH, Chiu AW
Page 102 and 103: 88 References83. Margrain TH. Minim
Page 104 and 105: 90 Appendix 1THE VERTEPORFIN PHOTOD
Page 106 and 107: 92 Appendix 11. Overview of Manual
Page 108 and 109: 94 Appendix 1And, if also collectin
Page 110 and 111: 96 Appendix 1more patients in the v
Page 112 and 113: 98 Appendix 12.4 Limitations of the
Page 114 and 115: 100 Appendix 1Box 2 Key advantages
Page 116 and 117: 102 Appendix 14. Study population4.
Page 118 and 119: 104 Appendix 15. Recruitment to the
Page 120 and 121: 106 Appendix 16. Background data co
Page 122 and 123: 108 Appendix 1Table 1: Schedule of
Page 124 and 125: 110 Appendix 1The Verteporfin Photo
Page 126 and 127: 112 Appendix 1• Additional clinic
Page 128 and 129: 114 Appendix 18. Recording adverse
Page 130 and 131: 116 Appendix 1level of benefit from
Page 132 and 133: 118 Appendix 1• comparison of num
Page 134 and 135: 120 Appendix 110.6 Sub-group analys
Page 136 and 137: 122 Appendix 112. Data issues12.1 D
Page 138 and 139: 124 Appendix 113. Organisation13.1
Page 140 and 141: 126 Appendix 114. References[1] Ref
Page 142 and 143: 128 Appendix 1Barnes RM, Gee L, Tay
Page 146 and 147: 132 Appendix 1Liverpool re-treatmen
Page 148 and 149: 134 Appendix 1Service StructurePlea
Page 150 and 151: 136 Appendix 1Has your photographer
Page 152 and 153: 138 Appendix 1There are many differ
Page 154 and 155: 140 Appendix 1testing on vision tes
Page 156 and 157: 142 Appendix 1something to do with
Page 158 and 159: 144 Appendix 1College of Ophthalmol
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Page 162 and 163: 148 Appendix 16.2 Subjective Refrac
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Page 192 and 193: 178 Appendix 1acute Trust; note tha
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180 Appendix 1Ophthalmologistrespon
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192 Appendix 3manufacturer’s pers
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FeedbackThe HTA programme and the a
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